is accepted for restricted use within NHS Scotland for the
treatment of external genital and perianal warts in
patients not suitable for podophyllotoxin or who have not
responded to treatment with podophyllotoxin.
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised
(October 2016) that green tea leaf extract (camellia
sinensis), (Catephen ®), is recommended for restricted use
within NHS Wales for the treatment of external genital and
perianal warts in patients not suitable for podophyllotoxin
or who have not responded to treatment with
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Camellia sinensis extract 100 mg per 1 gram Catephen 10%
Condylomata acuminata affecting the penis or the female
▶ Adult: Apply twice daily for 3 consecutive days,
treatment may be repeated at weekly intervals if
necessary for a total of five 3-day treatment courses,
direct medical supervision for lesions in the female and
for lesions greater than 4 cm2 in the male, maximum 50
single applications (‘loops’) per session (consult
Condylomata acuminata affecting the penis or the female
▶ Adult: Apply twice daily for 3 consecutive days,
treatment may be repeated at weekly intervals if
necessary for a total of four 3-day treatment courses,
direct medical supervision for lesions greater than
Condylomata acuminata affecting the penis or the female
▶ Adult: Apply twice daily for 3 consecutive days,
treatment may be repeated at weekly intervals if
necessary for a total of four 3-day treatment courses,
direct medical supervision for lesions greater than
, maximum 50 single applications (‘loops’) per
session (consult product literature)
l CAUTIONS Avoid normal skin . avoid open wounds . keep
away from face . very irritant to eyes
l SIDE-EFFECTS Balanoposthitis . skin irritation
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Butylated hydroxyanisole, cetostearyl alcohol
(including cetyl and stearyl alcohol), hydroxybenzoates (parabens), sorbic
Podophyllotoxin 1.5 mg per 1 gram Warticon 0.15% cream |
CAUTIONARY AND ADVISORY LABELS 15
Podophyllotoxin 5 mg per 1 ml Condyline 0.5% solution | 3.5 ml P £14.49 DT = £14.49
Podophyllotoxin 5 mg per 1 ml Warticon 0.5% solution | 3 ml P £14.86 DT = £14.86
ANTISEPTICS AND DISINFECTANTS ›
Warts, particularly plantar warts
▶ In children Licensed for use in children (age range not
l CAUTIONS Impaired peripheral circulation . not suitable
for application to anogenital region . not suitable for
application to face . not suitable for application to large
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: liquid
▶ Formaldehyde (Non-proprietary)
Formaldehyde 40 mg per 1 ml Formaldehyde (Buffered) 4%
solution | 1000 ml £3.90 DT = £3.90
Formaldehyde 350 mg per 1 gram Formaldehyde solution | 500 ml
£7.24 DT = £7.24 | 2000 ml £18.72
Warts, particularly plantar warts
▶ In children Licensed for use in children (age range not
l CAUTIONS Not for application to anogenital areas . not for
application to face . not for application to mucosa . protect
▶ Rare or very rare Severe cutaneous adverse reactions
▶ Frequency not known Rash . skin irritation (discontinue if
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Glutarol (Dermal Laboratories Ltd)
Glutaraldehyde 100 mg per 1 ml Glutarol 10% cutaneous solution | 10 ml p £2.07 DT = £2.07
1284 Warts and calluses BNF 78
ANTISEPTICS AND DISINFECTANTS › OTHER
▶ Child: Apply every 24 hours for up to 3 applications,
apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
▶ Adult: Apply every 24 hours for up to 3 applications,
apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
▶ Child: Apply every 24 hours for up to 6 applications,
apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
▶ Adult: Apply every 24 hours for up to 6 applications,
apply moistened caustic pencil tip for 1–2 minutes.
Instructions in proprietary packs generally incorporate
advice to remove dead skin before use by gentle filing
and to cover with adhesive dressing after application
▶ Child: Apply moistened caustic pencil tip (usually
containing silver nitrate 40%) for 1–2 minutes, protect
surrounding skin with soft paraffin
▶ Adult: Apply moistened caustic pencil tip (usually
containing silver nitrate 40%) for 1–2 minutes, protect
surrounding skin with soft paraffin
▶ In children No age range specified by manufacturer.
l CAUTIONS Avoid broken skin . not suitable for application
▶ Rare or very rare Argyria . methaemoglobinaemia
l PATIENT AND CARER ADVICE Patients should be advised
that silver nitrate may stain fabric.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Silver nitrate 400 mg per 1 gram Avoca 40% silver nitrate pencils
| 1 applicator p £1.13 DT = £1.13
Silver nitrate 750 mg per 1 gram Avoca 75% silver nitrate
applicators | 100 applicator p £47.82
Avoca 75% silver nitrate applicators with thick handles | 50 applicator p £47.19
Silver nitrate 950 mg per 1 gram Avoca 95% silver nitrate
applicators | 100 applicator p £51.17
Avoca 95% silver nitrate pencils | 1 applicator p £2.56 DT = £3.08
Avoca wart and verruca treatment set | 1 applicator p £3.08 DT =
ANTIVIRALS › IMMUNE RESPONSE MODIFIERS
Warts (external genital and perianal)
▶ Adult: Apply 3 times a week until lesions resolve
(maximum 16 weeks), to be applied thinly at night
Superficial basal cell carcinoma
▶ Adult: Apply daily for 5 nights of each week for
6 weeks, to be applied to lesion and 1 cm beyond it,
assess response 12 weeks after completing treatment
▶ Adult: Apply 3 times a week for 4 weeks, to be applied
to lesion at night, assess response after a 4 week
treatment-free interval; repeat 4-week course if lesions
▶ Adult: Apply once daily for 2 weeks, to be applied at
bedtime to lesion on face or balding scalp, repeat
course after a 2-week treatment-free interval, assess
response 8 weeks after second course; maximum
l CAUTIONS Autoimmune disease . avoid broken skin . avoid
contact with eyes . avoid contact with lips . avoid contact
with nostrils . avoid open wounds . immunosuppressed
▶ Uncommon Anorectal disorder. chills . conjunctival
▶ Rare or very rare Autoimmune disorder exacerbated
▶ Frequency not known Alopecia . cutaneous lupus
erythematosus . severe cutaneous adverse reactions
l CONCEPTION AND CONTRACEPTION May damage latex
l PREGNANCY No evidence of teratogenicity or toxicity in
animal studies; manufacturer advises caution.
l BREAST FEEDING No information available.
l DIRECTIONS FOR ADMINISTRATION
ZYCLARA ® ▶ Important Should be rubbed in and allowed
to stay on the treated area for 8 hours, then washed off
ALDARA ® ▶ Important Should be rubbed in and allowed to
stay on the treated area for 6–10 hours for warts or for
8 hours for basal cell carcinoma and actinic keratosis, then
washed off with mild soap and water (uncircumcised males
treating warts under foreskin should wash the area daily).
The cream should be washed off before sexual contact.
BNF 78 Warts and calluses 1285
l PATIENT AND CARER ADVICE A patient information leaflet
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10
EXCIPIENTS: May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), hydroxybenzoates (parabens), polysorbates
▶ Aldara (Meda Pharmaceuticals Ltd)
Imiquimod 50 mg per 1 gram Aldara 5% cream 250mg sachets | 12 sachet P £48.60 DT = £48.60
▶ Zyclara (Meda Pharmaceuticals Ltd)
Imiquimod 37.5 mg per 1 gram Zyclara 3.75% cream 250mg sachets
| 28 sachet P £54.75 DT = £54.75
SALICYLIC ACID AND DERIVATIVES
▶ Child: Apply daily, treatment may need to be continued
▶ Adult: Apply daily, treatment may need to be
▶ Child: Apply daily, treatment may need to be continued
▶ Adult: Apply daily, treatment may need to be
▶ In children Not licensed for use in children under 2 years.
l CAUTIONS Avoid broken skin . impaired peripheral
circulation . not suitable for application to anogenital
region . not suitable for application to face . not suitable
for application to large areas . patients with diabetes at risk
of neuropathic ulcers . significant peripheral neuropathy
l SIDE-EFFECTS Skin irritation
l PATIENT AND CARER ADVICE Advise patient to apply
carefully to wart and to protect surrounding skin (e.g. with
soft paraffin or specially designed plaster); rub wart
surface gently with file or pumice stone once weekly.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Verrugon (Optima Consumer Health Ltd)
Salicylic acid 500 mg per 1 gram Verrugon complete 50% ointment
CAUTIONARY AND ADVISORY LABELS 15
▶ Occlusal (Alliance Pharmaceuticals Ltd)
Salicylic acid 260 mg per 1 ml Occlusal 26% solution | 10 ml p
Salicylic acid with lactic acid
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, salicylic acid above.
Plantar and mosaic warts | Corns | Calluses
▶ Adult: Apply once daily, treatment may need to be
▶ Adult: Apply daily, treatment may need to be
Warts, particularly plantar warts | Verrucas | Corns |
▶ Adult: Apply daily, treatment may need to be
Warts | Verrucas | Corns | Calluses
▶ Adult: Apply daily, treatment may need to be
l PRESCRIBING AND DISPENSING INFORMATION
Preparations of salicylic acid in a collodion basis (Cuplex ®
and Salactol ®) are available but some patients may
develop an allergy to colophony in the formulation.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 15
▶ Duofilm (GlaxoSmithKline UK Ltd)
Lactic acid 150 mg per 1 gram, Salicylic acid 167 mg per
1 gram Duofilm paint | 15 ml p £2.25 DT = £2.25
▶ Salactol (Dermal Laboratories Ltd)
Lactic acid 167 mg per 1 gram, Salicylic acid 167 mg per
1 gram Salactol paint | 10 ml p £1.71 DT = £1.71
CAUTIONARY AND ADVISORY LABELS 15
▶ Salatac (Dermal Laboratories Ltd)
Lactic acid 40 mg per 1 gram, Salicylic acid 120 mg per
1 gram Salatac gel | 8 gram p £2.98 DT = £2.98
1286 Warts and calluses BNF 78
1 Immunoglobulin therapy page 1287
2 Post-exposure prophylaxis 1293
3 Tuberculosis diagnostic test page 1294
IMMUNE SERA AND IMMUNOGLOBULINS ›
Immunity with immediate protection against certain
infective organisms can be obtained by injecting
preparations made from the plasma of immune individuals
with adequate levels of antibody to the disease for which
protection is sought. The duration of this passive immunity
varies according to the dose and the type of
immunoglobulin. Passive immunity may last only a few
weeks; when necessary, passive immunisation can be
repeated. Antibodies of human origin are usually termed
immunoglobulins. The term antiserum is applied to material
prepared in animals. Because of serum sickness and other
allergic-type reactions that may follow injections of antisera,
this therapy has been replaced wherever possible by the use
of immunoglobulins. Reactions are theoretically possible
after injection of human immunoglobulins but reports of
Two types of human immunoglobulin preparation are
available, normal immunoglobulin p. 1290 and diseasespecific immunoglobulins.
Human immunoglobulin is a sterile preparation of
concentrated antibodies (immune globulins) recovered from
pooled human plasma or serum obtained from outside the
UK, tested and found non-reactive for hepatitis B surface
antigen and for antibodies against hepatitis C virus and
human immunodeficiency virus (types 1 and 2). A global
shortage of human immunoglobulin and the rapidly
increasing range of clinical indications for treatment with
immunoglobulins has resulted in the need for a Demand
Management programme in the UK, for further information
consult www.ivig.nhs.uk and Clinical Guidelines for
Immunoglobulin Use, www.gov.uk/dh.
Further information on the use of immunoglobulins is
included in Public Health England’s Immunoglobulin
Handbook, www.gov.uk/phe, and in the Department of
Health’s publication, Immunisation against Infectious Disease,
Normal immunoglobulin for intramuscular administration is
available from some regional Public Health laboratories for
protection of contacts and the control of outbreaks of
hepatitis A, measles, and rubella only. For other indications,
subcutaneous or intravenous normal immunoglobulin
should be purchased from the manufacturer.
Disease-specific immunoglobulins are available from
some regional Public Health laboratories, with the exception
of tetanus immunoglobulin p. 1292 which is available from
BPL, hospital pharmacies, or blood transfusion departments.
Rabies immunoglobulin p. 1292 is available from the
Specialist and Reference Microbiology Division, Public
Health England, Colindale. Hepatitis B immunoglobulin
p. 1290 required by transplant centres should be obtained
In Scotland all immunoglobulins are available from the
Scottish National Blood Transfusion Service (SNBTS).
In Wales all immunoglobulins are available from the Welsh
In Northern Ireland all immunoglobulins are available
from the Northern Ireland Blood Transfusion Service (NIBTS).
Human normal immunoglobulin (‘HNIG’) is prepared from
pools of at least 1000 donations of human plasma; it
contains immunoglobulin G (IgG) and antibodies to hepatitis
A, measles, mumps, rubella, varicella, and other viruses that
are currently prevalent in the general population.
Normal immunoglobulin (containing 10%–18% protein) is
administered by intramuscular injection for the protection of
susceptible contacts against hepatitis A virus (infectious
hepatitis), measles and, to a lesser extent, rubella. Injection
of immunoglobulin produces immediate protection lasting
Normal immunoglobulin (containing 3%–12% protein) for
intravenous administration is used as replacement therapy for
patients with congenital agammaglobulinaemia and
hypogammaglobulinaemia, and for the short-term treatment
of idiopathic thrombocytopenic purpura and Kawasaki
disease; it is also used for the prophylaxis of infection
following bone-marrow transplantation and in children with
symptomatic HIV infection who have recurrent bacterial
infections. Normal immunoglobulin for replacement therapy
may also be given intramuscularly or subcutaneously, but
intravenous formulations are normally preferred.
Intravenous immunoglobulin is also used in the treatment of
Guillain-Barré syndrome as an alternative to plasma
For guidance on the use of intravenous normal
immunoglobulin and alternative therapies for certain
conditions, consult Clinical Guidelines for Immunoglobulin
Hepatitis A vaccine p. 1318 is recommended for individuals
at risk of infection including those visiting areas where the
disease is highly endemic (all countries excluding Northern
and Western Europe, North America, Japan, Australia, and
New Zealand). In unimmunised individuals, transmission of
hepatitis A is reduced by good hygiene. Intramuscular
normal immunoglobulin is no longer recommended for
Public Health England recommends the use of normal
immunoglobulin in addition to hepatitis A vaccine for
prevention of infection in close contacts (of confirmed cases
BNF 78 Immunoglobulin therapy 1287
of hepatitis A) who are 60 years of age or over, have chronic
liver disease (including chronic hepatitis B or C infection), or
HIV infection (with a CD4 count < 200 cells per microlitre),
or who are immunosuppressed; normal immunoglobulin
should be given as soon as possible, preferably within
14 days of exposure to the primary case. However, normal
immunoglobulin can still be given to contacts with chronic
liver disease up to 28 days after exposure to the primary case.
Hepatitis A vaccine can be given at the same time, but it
should be given at a separate injection site.
Intravenous or subcutaneous normal immunoglobulin may
be given to prevent or attenuate an attack of measles in
individuals who do not have adequate immunity. Patients
with compromised immunity who have come into contact
with measles should receive intravenous or subcutaneous
normal immunoglobulin as soon as possible after exposure.
It is most effective if given within 72 hours but can be
effective if given within 6 days.
Subcutaneous or intramuscular normal immunoglobulin
should also be considered for the following individuals if
they have been in contact with a confirmed case of measles
or with a person associated with a local outbreak:
Further advice should be sought from the Centre for
Infections, Public Health England (tel. (020) 8200 6868).
Individuals with normal immunity who are not in the
above categories and who have not been fully immunised
against measles, can be given measles, mumps and rubella
vaccine, live p. 1323 for prophylaxis following exposure to
Intramuscular immunoglobulin after exposure to rubella
does not prevent infection in non-immune contacts and is
not recommended for protection of pregnant women
exposed to rubella. It may, however, reduce the likelihood of
a clinical attack which may possibly reduce the risk to the
fetus. Risk of intra-uterine transmission is greatest in the
first 11 weeks of pregnancy, between 16 and 20 weeks there
is minimal risk of deafness only, after 20 weeks there is no
increased risk. Intramuscular normal immunoglobulin
should be used only if termination of pregnancy would be
unacceptable to the pregnant woman—it should be given as
soon as possible after exposure. Serological follow-up of
recipients is essential to determine if the woman has become
infected despite receiving immunoglobulin.
For routine prophylaxis against Rubella, see measles,
mumps and rubella vaccine, live p. 1323.
Disease-specific immunoglobulins
Specific immunoglobulins are prepared by pooling the
plasma of selected human donors with high levels of the
specific antibody required. For further information, see
Immunoglobulin Handbook (www.gov.uk/phe).
There are no specific immunoglobulins for hepatitis A,
measles, or rubella— normal immunoglobulin p. 1290 is used
in certain circumstances. There is no specific
immunoglobulin for mumps; neither normal
immunoglobulin nor measles, mumps and rubella vaccine,
live is effective as post-exposure prophylaxis.
Disease-specific hepatitis B immunoglobulin p. 1290
(‘HBIG’) is available for use in association with hepatitis B
vaccine p. 1319 for the prevention of infection in laboratory
and other personnel who have been accidentally inoculated
with hepatitis B virus, and in infants born to mothers who
have become infected with this virus in pregnancy or who are
high-risk carriers. Hepatitis B immunoglobulin will not
inhibit the antibody response when given at the same time
as hepatitis B vaccine but should be given at different sites.
An intravenous and subcutaneous preparation of hepatitis B
immunoglobulin is licensed for the prevention of hepatitis B
recurrence in HBV-DNA negative patients who have
undergone liver transplantation for liver failure caused by
Following exposure of an unimmunised individual to an
animal in or from a country where the risk of rabies is high
the site of the bite should be washed with soapy water and
specific rabies immunoglobulin p. 1292 of human origin
administered. All of the dose should be injected around the
site of the wound; if this is difficult or the wound has
completely healed it can be given in the anterolateral thigh
(remote from the site used for vaccination).
Rabies vaccine p. 1324 should also be given
intramuscularly at a different site (for details see rabies
vaccine). If there is delay in giving the rabies
immunoglobulin, it should be given within 7 days of starting
For the management of tetanus-prone wounds, tetanus
immunoglobulin p. 1292 should be used in addition to
wound cleansing and, where appropriate, antibacterial
prophylaxis and a tetanus-containing vaccine. Tetanus
immunoglobulin, together with metronidazole p. 542 and
wound cleansing, should also be used for the treatment of
Varicella–zoster immunoglobulin
Varicella-zoster immunoglobulin p. 1292 (VZIG) is
recommended for individuals who are at increased risk of
severe varicella (neonates, pregnant women and
immunosuppressed individuals with varicella-zoster virus
immunoglobulin G antibody less than 150 mIU/mL) and who
have no antibodies to varicella–zoster virus and who have
significant exposure to chickenpox (varicella) or shingles
(herpes zoster) during the infectious period.
Immunosuppressed patients receiving regular intravenous
administered more than 3 weeks before exposure.
Immunosuppressed patients on long term aciclovir p. 633
or valaciclovir p. 636 prophylaxis will require a temporary
increase in their dose following exposure; for patients within
12 months of a stem cell transplant, varicella-zoster
immunoglobulin should also be considered.
Important: for full details consult Guidance for issuing
varicella-zoster immunoglobulin (VZIG) and Immunisation
against infectious disease from Public Health England
Anti-D (Rh0) immunoglobulin p. 1289 is prepared from
plasma taken from rhesus-negative donors who have been
immunised against the anti-D-antigen. Anti-D (Rh0)
immunoglobulin is used to prevent a rhesus-negative
mother from forming antibodies to fetal rhesus-positive cells
which may pass into the maternal circulation. The objective
is to protect any subsequent child from the hazard of
haemolytic disease of the newborn.
Anti-D (Rh0) immunoglobulin should be administered to
the mother following any sensitising episode (e.g. abortion,
miscarriage and birth); it should be injected within 72 hours
of the episode but even if a longer period has elapsed it may
still give protection and should be administered. Anti-D
during delivery. The dose of anti-D (Rh0) immunoglobulin is
determined according to the level of exposure to rhesuspositive blood.
Use of routine antenatal anti-D prophylaxis should be
given irrespective of previous anti-D prophylaxis for a
1288 Immunoglobulin therapy BNF 78
sensitising event early in the same pregnancy. Similarly,
postpartum anti-D prophylaxis should be given irrespective
of previous routine antenatal anti-D prophylaxis or
antenatal anti-D prophylaxis for a sensitising event in the
Anti-D (Rh0) immunoglobulin is also given to women of
child-bearing potential after the inadvertent transfusion of
rhesus-incompatible blood components and is used for the
treatment of idiopathic thrombocytopenia purpura.
Measles, mumps and rubella vaccine, live may be given in
the postpartum period with anti-D (Rh0) immunoglobulin
injection provided that separate syringes are used and the
products are administered into different limbs. If blood is
transfused, the antibody response to the vaccine may be
inhibited—measure rubella antibodies after 6–8 weeks and
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following birth of rhesus-positive infant
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 500 units, dose to be
administered immediately or within 72 hours; for
transplacental bleed of over 4 mL fetal red cells, extra
100–125 units per mL fetal red cells, subcutaneous
route used for patients with bleeding disorders
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following any potentially sensitising
episode (e.g. stillbirth, abortion, amniocentesis) up to
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 250 units per episode,
dose to be administered immediately or within
72 hours, subcutaneous route used for patients with
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following any potentially sensitising
episode (e.g. stillbirth, abortion, amniocentesis) after
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 500 units per episode,
dose to be administered immediately or within
72 hours, subcutaneous route used for patients with
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, antenatal prophylaxis
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 500 units, dose to be
within 72 hours of delivery, subcutaneous route used
for patients with bleeding disorders
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, antenatal prophylaxis (alternative NICE
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 1000–1650 units, dose
to be given at weeks 28 and 34 of pregnancy,
alternatively 1500 units for 1 dose, dose to be given
between 28 and 30 weeks gestation
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following Rh0(D) incompatible blood
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 100–125 units per mL
of transfused rhesus-positive red cells, subcutaneous
route used for patients with bleeding disorders
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following birth of rhesus-positive infant
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
▶ Females of childbearing potential: 1000–1500 units, dose
to administered immediately or within 72 hours; for
large transplacental bleed, extra 100 units per mL fetal
red cells (preferably by intravenous injection),
intravenous route recommended for patients with
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following any potentially sensitising
episode (e.g. abortion, amniocentesis, chorionic villous
sampling) up to 12 weeks’ gestation
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
▶ Females of childbearing potential: 1000 units per
episode, dose to be administered immediately or within
72 hours, intravenous route recommended for patients
with bleeding disorders, higher doses may be required
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, antenatal prophylaxis
▶ BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
▶ Females of childbearing potential: 1500 units, dose to be
given between weeks 28–30 of pregnancy; if infant
rhesus-positive, a further dose is still needed
immediately or within 72 hours of delivery,
intravenous route recommended for patients with
To rhesus-negative woman for prevention of Rh0(D)
sensitisation, following Rh0(D) incompatible blood
▶ Females of childbearing potential: 50 units per mL of
transfused rhesus-positive blood, alternatively
100 units per of mL of erythrocyte concentrate,
intravenous route recommended for patients with
l CONTRA-INDICATIONS Treatment of idiopathic
l CAUTIONS Immunoglobulin A deficiency . possible
interference with live virus vaccines
▶ MMR vaccine MMR vaccine may be given in the postpartum
period with anti-D (Rh0) immunoglobulin injection
provided that separate syringes are used and the products
are administered into different limbs. If blood is
transfused, the antibody response to the vaccine may be
inhibited—measure rubella antibodies after 6–8 weeks and
l INTERACTIONS → Appendix 1: immunoglobulins
▶ Uncommon Chills . fever. headache . malaise . skin
▶ Frequency not known Intravascular haemolysis
BNF 78 Immunoglobulin therapy 1289
l HANDLING AND STORAGE Care must be taken to store all
immunological products under the conditions
recommended in the product literature, otherwise the
preparation may become ineffective. Refrigerated
storage is usually necessary; many immunoglobulins need
to be stored at 2–8°C and not allowed to freeze.
Immunoglobulins should be protected from light. Opened
multidose vials must be used within the period
recommended in the product literature.
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Routine antenatal anti-D prophylaxis for rhesus-negative
women (August 2008) NICE TA156
Routine antenatal anti-D prophylaxis should be offered to
all non-sensitised pregnant women who are rhesus
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ D-Gam (Bio Products Laboratory Ltd)
Anti-D (RHO) immunoglobulin 500 unit D-Gam Anti-D
immunoglobulin 500unit solution for injection vials | 1 vial P £38.25
Anti-D (RHO) immunoglobulin 1500 unit D-Gam Anti-D
immunoglobulin 1,500unit solution for injection vials | 1 vial P £58.00
▶ Rhophylac (CSL Behring UK Ltd)
Anti-D (RHO) immunoglobulin 750 unit per 1 ml Rhophylac
1,500units/2ml solution for injection pre-filled syringes | 1 pre-filled
Prophylaxis against hepatitis B infection
▶ Adult: 500 units, dose to be administered as soon as
possible after exposure; ideally within 12–48 hours,
but no later than 7 days after exposure
Prophylaxis against hepatitis B infection, after exposure
to hepatitis B virus-contaminated material
▶ Adult: Dose to be administered as soon as possible after
exposure, but no later than 72 hours (consult product
Prevention of hepatitis B in haemodialysed patients
▶ Adult: (consult product literature)
Prophylaxis against re-infection of transplanted liver
▶ Adult: (consult product literature)
Prevention of hepatitis B re-infection more than 6 months
after liver transplantation in stable HBV-DNA negative
▶ Adult (body-weight up to 75 kg): 500 units once weekly,
increased if necessary up to 1000 units once weekly,
dose to be started 2–3 weeks after last dose of
intravenous hepatitis B immunoglobulin
▶ Adult (body-weight 75 kg and above): 1000 units once
weekly, dose to be started 2–3 weeks after last dose of
intravenous hepatitis B immunoglobulin
l CAUTIONS IgA deficiency . interference with live virus
l INTERACTIONS → Appendix 1: immunoglobulins
▶ Uncommon Abdominal pain upper. headache
spasms . nasopharyngitis . oropharyngeal pain . palpitations . skin reactions
l PRESCRIBING AND DISPENSING INFORMATION Vials
containing 200 units or 500 units (for intramuscular
injection), available from selected Public Health England
and NHS laboratories (except for Transplant Centres), also
l HANDLING AND STORAGE Care must be taken to store all
immunological products under the conditions
recommended in the product literature, otherwise the
preparation may become ineffective. Refrigerated
storage is usually necessary; many immunoglobulins need
to be stored at 2–8°C and not allowed to freeze.
Immunoglobulins should be protected from light. Opened
multidose vials must be used within the period
recommended in the product literature.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Hepatitis B immunoglobulin (Non-proprietary)
Hepatitis B immunoglobulin human 200 unit Hepatitis B
immunoglobulin human 200unit solution for injection vials | 1 vial P £200.00
Hepatitis B immunoglobulin human 500 unit Hepatitis B
immunoglobulin human 500unit solution for injection vials | 1 vial P £400.00
Zutectra 500units/1ml solution for injection pre-filled syringes | 5 syringe P £1,500.00
▶ Hepatect CP (Biotest (UK) Ltd)
Hepatitis B immunoglobulin human 50 unit per 1 ml Hepatect CP
100units/2ml solution for infusion vials | 1 vial P £55.00
Hepatect CP 2000units/40ml solution for infusion vials | 1 vial P £1,100.00
Hepatect CP 500units/10ml solution for infusion vials | 1 vial P £275.00
Hepatect CP 5000units/100ml solution for infusion vials | 1 vial P £2,750.00
▶ Omri-Hep-B (Imported (Israel))
Hepatitis B immunoglobulin human 50 unit per 1 ml Omri-Hep-B
5000units/100ml solution for infusion vials | 1 vial P s
Normal immunoglobulin 06-Sep-2017
To control outbreaks of hepatitis A
▶ BY DEEP INTRAMUSCULAR INJECTION
Rubella in pregnancy, prevention of clinical attack
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Females of childbearing potential: 750 mg
▶ Adult: (consult product literature)
Hepatitis A prophylaxis in outbreaks
SUBGAM ® Subgam® is not licensed for prophylactic use,
but due to difficulty in obtaining suitable immunoglobulin
products, Public Health England recommends
intramuscular use for prophylaxis against Hepatitis A or
l CONTRA-INDICATIONS Patients with selective IgA
deficiency who have known antibody against IgA
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